Inappropriate use of large healthcare structures

The healthcare system has many resources that can be used appropriately, or not. Think of the child with fever who leaves the paediatrician’s office with a prescription of antibiotics, the elderly lady who ends her days in an intensive bed, when, in their case, a palliative action would have been more appropriate or the person with a moderate headache, without other neurological manifestations, which, by insistence, ends up undergoing a tomography. George Halvorson, in "Health care will not reform itself", echoes an investigation that, after reviewing 5 million medical records, concluded that waste due to clinical practices that don’t add value could be considered to reach at least 25% of the total health expenditure.

This waste affects practically all areas of healthcare, but now I would like to focus on what happens with the inadequacy of the use of large health structures: operating theaters, emergencies units, intensive care units, wards and primary care.

Kaiser Permanente: the keys to success

Kaiser Permanente (KP) is an integrated managed care consortium, acting in California, and to a lesser extent on 8 other U.S. states. In the series of "Virtual Clinical Practice" I have already made ​​a brief presentation of the most relevant features of Kaiser Permanente to better understand the development of Health Connect, the electronic medical record of this insurer.

KP Results

What attracts us, European health managers, to KP are their excellent results, both in adjusted resource utilisation as well as in the quality of care which contrasts to the American environment where inequities in access, organisational and medical performance disorder prevails. To illustrate what I mean I have chosen this article:

Waste due to clinical management according to Berwick and Halvorson

Donald Berwick’s reviews have a great impact in the US, as well as being for a short period of time the CMS Administrator, surely the public health agency that moves the biggest budget in the world, was very well known in his time as the President of the Institute for Healthcare Improvement. Berwick and his colleague Hackbarth in this JAMA article, put a value on the waste of resources in the US. They say the cross cuts do not promote structural change and that in exchange, they can damage services of proven quality. For this reason, the study's authors strive to show where the waste is, i.e. where there are performances that if left out, the quality would remain unaffected or may even improve.

The authors believe that the overall savings of the system could be in a range going from 21% to 47%, but if you read the article carefully and ignore the parts about the complexities specific to the American system, it turns out that the estimate obtained out of the waste due to clinical errors, poor coordination between levels of care and overtreatment, would be as indicated in the chart above, at an average value of 13% and a range that would go from 12 to 16%.